Submission form for New Zealand burlesque name database

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This is the submission form to have your details uploaded to the New Zealand burlesque name database.

Email *

Region - where are you based in New Zealand? *

Northland

Auckland

Waikato

Bay of Plenty

Gisborne

Hawke's Bay

Taranaki

Whanganui-Manawatu

Wellington

Marlborough

Nelson-Tasman

West Coast

Canterbury

Otago

Southland

First Name - what is the first name of your stage name *

Last Name - does your stage name have a last name? *

if not add a dash e.g. -

Phone number - do you have a cell phone you can be contacted on for media or bookings

Are you seeking corporate gigs/hen's parties? *

Yes

Website - what is your performer website?

Social media - what is your facebook? *

Please copy the full web address e.g. https://www.facebook.com/CrystalMisschief, thank you!

Social media - what is your instagram?

Please copy the full web address e.g. https://www.instagram.com/crystalmischief, thank you!

Current status *

Currently working and looking for gigs

Taking a break and will return

Permanently retired, not returning to burlesque

Partially retired - contact for availability

First use date - what date did you first use your name? *

YYYY

What information do you want published on the database *

My name, region and date of first use

My name, region, date of first use, social media

My name, region, date of first use, social media, website

My name, region, date of first use, social media, website and phone number

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

Forms

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google.